Latest procedures for medical examination and treatment under health insurance.

What documents do I need to bring when going for medical examination and treatment covered by health insurance? What are the procedures for medical examination and treatment covered by health insurance? Please refer to the article below.

The latest procedures for medical examination and treatment under health insurance are guided by Decision 4384/QD-BYT of 2023, specifically as follows:

1. Latest health insurance medical records

The latest health insurance medical records include:

- Health insurance card and proof of identity; for children under 6 years old, only the health insurance card needs to be presented.

- A copy of the birth certificate or a copy of the birth registration certificate for children under 6 years old.

- Declaration form for participation in and adjustment of social insurance and health insurance information according to Form TK1-TS (Issued together with Decision 490/QD-BHXH dated March 28, 2023).

- Form No. 5. Follow-up appointment slip.

- Form No. 6. Referral form for health insurance medical examination and treatment.

- Referral documents from the health insurance medical facility.

Note: Patients do not need to present all of the above documents; depending on the specific case as outlined in section 2, they should present the corresponding documents.

2. Latest procedures for medical examination and treatment under health insurance.

Step 1: For those participating in health insurance.

(1) When visiting a medical examination and treatment facility, health insurance participants must present a health insurance card with a photo or citizen identification card; in case of presenting a health insurance card without a photo, they must also present one of the following documents with a photo issued by a competent agency or organization, or a confirmation from the commune police, or other documents with confirmation from the educational institution managing the student; other legally valid identity documents or documents with level 2 electronic identification as prescribed in Decree 59/2022/ND-CP; for children under 6 years old, only a health insurance card needs to be presented.

(2) In case of emergency, health insurance participants can receive medical examination and treatment at any medical facility and must present their health insurance card along with the documents specified in (i) before discharge.

(3) In case of referral for treatment, the health insurance participant must have a referral form for medical examination and treatment under health insurance, and the referral file from the medical facility.

(4) In case of follow-up examination as required for treatment, the health insurance participant must have a follow-up appointment slip from the medical facility.

(5) In case of exceeding the professional and technical capacity, the health insurance medical examination and treatment facility is responsible for promptly transferring the patient to another health insurance medical examination and treatment facility according to the regulations on professional and technical referral.

(6) Some specific cases for health insurance participants:

6.1. Individuals participating in health insurance must present their health insurance card with a photo or citizen identification card when receiving medical examination or treatment. If the health insurance card does not have a photo, they must also present one of the following photo identification documents issued by a competent authority or organization, a confirmation letter from the commune-level police, or other documents certified by the educational institution managing the student; other legally valid identity documents; or documents with level 2 electronic identification as stipulated in Decree 59/2022/NĐ-CP.

6.2. Children under 6 years old only need to present their health insurance card when seeking medical treatment.

If a child has not yet been issued a health insurance card, a copy of the birth certificate or birth registration certificate must be presented; if immediate treatment is required after birth but a birth certificate is not yet available, the head of the medical facility and the child's father or mother or guardian must sign a confirmation in the medical record to serve as the basis for payment as stipulated in Clause 1, Article 27 of Decree 146/2018/NĐ-CP and are responsible for this confirmation.

6.3. Individuals participating in health insurance while awaiting card reissuance or replacement must present the Social Insurance and Health Insurance Information Adjustment Declaration Form (Form TK1-TS, issued with Decision 490/QD-BHXH dated March 28, 2023) and a document proving their identity when seeking medical treatment.

6.4. Individuals who have donated organs and are seeking medical examination or treatment must present the documents specified in 6.1 or 6.3. If immediate treatment is required after donation, the head of the medical facility where the organ was taken and the patient or their family member must sign a confirmation in the medical record to serve as the basis for payment as stipulated in Clause 2, Article 27 of Decree 146/2018/NĐ-CP.

6.5. In case of referral for medical examination and treatment, the health insurance participant must present the referral documents from the medical facility and the Referral Form No. 6 in the Appendix issued with Decree 75/2023/ND-CP. If the referral form is valid until December 31st of the calendar year but the treatment period has not ended, the referral form may be used until the end of the treatment period.

In cases of follow-up examinations as required for treatment, health insurance participants must have a follow-up appointment slip from the medical facility, using Form No. 5 in the Appendix issued with Decree 75/2023/NĐ-CP.

6.6. In emergency cases, health insurance participants may receive medical examination and treatment at any medical facility and must present the documents specified in Clause 6, Article 1 of Decree 75/2023/ND-CP or Clause 2 or Clause 3, Article 15 of Decree 146/2018/ND-CP before discharge. Once the emergency phase is over, the medical facility will transfer the patient to another department or ward within the same facility for continued monitoring and treatment, or refer them to another medical facility. This is considered as receiving treatment within the designated referral system.

6.7. Individuals participating in health insurance who are on business trips, working remotely, studying full-time under training programs, or temporarily residing in Vietnam are entitled to initial medical examination and treatment at a medical facility of the same technical specialization or equivalent to the initial medical facility registered on their health insurance card. They must present the documents specified in Clause 6, Article 1 of Decree 75/2023/ND-CP or Clause 2 or Clause 3, Article 15 of Decree 146/2018/ND-CP and one of the following documents (original or copy): business trip document, decision to send to study, student ID card, temporary residence registration document, or school transfer document.

Step 2: For healthcare facilities

- The healthcare organization ensures quality medical examination and treatment with simple and convenient procedures for health insurance participants.

- Receiving patients with health insurance cards into medical facilities for diagnosis and treatment.

Source: https://baoquocte.vn/thu-tuc-kham-chua-benh-bhyt-moi-nhat-252843.html